Centering the Health-Care Debate

A couple of key words change everything. Google the phrase “universal health care,” and you get over 30 million results. Google “sacrifice for universal health care,” and you’ll get under 200,000. We are ignoring the “universal” part of universal health care. While emphasizing that reforms would cover everyone, we’re at the same time forgetting that this goal requires similarly extensive sacrifice; as a result, our nation’s health-care debate ignores the central issue frustrating its advancement. Both conservative and liberal camps should realize that the chief problem is one of theory, not policy. Correcting health care should not be construed primarily as a matter of dollars and cents, but seen as a referendum, in essence, on public morality.

As long as the prevailing moral discourse in America maintains its current notions, reforming our system of medical care is impossible.

More specifically, health-care advocates need to abandon ethics that prioritize the self over the common good in order for their efforts to bear fruit. Such privileging of autonomy extends from a series of judgments latent in contemporary common wisdom about morality—first, that each person should be free to pursue his desires so long as he does not harm anyone else; second, that such desires cannot be judged inferior to those of someone else. Taken together, these two judgments mean that health-care reform is incompatible with our national moral ethos. Public option or not, finding some way to extend care to the uninsured requires at least some sacrifice by those who are adequately covered under the current system. On an economic level, reform includes inherently sacrificial effort. Welcome or not, redistribution of our fixed resources to a wider group must inconvenience at least some people. Whether through higher taxes, increased premiums, or longer wait times, Americans will suffer at least marginally to provide medical care for a stranger.

Americans seem willing to make this sacrifice, but just barely. About one half of Americans support health-care reform, even though only roughly one fifth of Americans predict a material gain from such support of a national system. According to a recent CBS poll, only 22 percent of Americans “said the reforms now being considered would help them personally,” while 30 percent even believed that “reforms would hurt them personally.” In the same poll, 53 percent favored “the government offering everyone a government administered health insurance plan that would compete with private health insurance plans,” with similar numbers evident under other reform plans. That three percent margin keeping health care on the table is likely to disappear.

Why? Because society’s moral axioms enervate attempts to convince the public to join this slim majority. Since Americans now shy away from a hierarchy of moral preferences, even those who would maintain their current care based on selfishness cannot be condemned. If forsaking current comforts for others would not be obligatory under our contemporary moral decorum, appeals for medical reform would then lose nearly all their persuasive force. While objectors rightly note that inaction hurts the uninsured, precisely because the currently comfortable might intend no harm, this complaint proves relevant but non-essential. In our modern mindset, sacrifice for the sake of another is obviously an act above and beyond the call of duty. We applaud the person who sacrifices for the stranger dying in the street, but we do not force others to follow suit. To the reform obstructionist who sees universal health care as a type of forced charity, society can say nothing and must even remain silent.

Our reawakened consciousness to the plight of the uninsured is anchored within our moral framework. The intellectual backing necessary for its success, however, is not. The health-care debate serves as only one instance of this more general conflict between compassion and conscience. Our collective moral outlook appears purposefully structured, above all, to not offend and to avoid dogmatic statements that seem improvable. Even disapprobation toward a selfish man seems out of place. His hoarding might not be laudable, but each of us is hesitant to claim definite knowledge of his moral worth. In a widespread effort such as national medical reform, compassion requires conscience in order to work. On a solely pragmatic level, without appeal to a sense of duty, the mind of the dissident will remain unchanged.

Advocates of health-care change would do well to keep in mind America’s touchiness with the rhetoric of sacrifice. Our baseline moral assumptions frustrate the efforts of health-care reform advocates, who are in the uncommon and precarious position of asking U.S. citizens to sacrifice their autonomy for the greater good.

By skipping over the fundamental question of the rationale for reform, our legislators have taken the politically expedient route. And by ignoring Americans’ moral discomfort with issues of self-denial, reformers have allowed societal priorities to remain muddied. Providing moral clarity to the health-care debate would not have come without cost but would surely have offered direction to such an important national endeavor. Our marketplace of ideas might still be open to the discussion of all opinions, but a serious observer of today’s health-care debate could never guess it.